Veno-Arterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock and Cardiac Arrest

Cardiogenic shock (CS) following acute myocardial infarction (AMI) occurs in 7% to 9% of patients affected by AMI with a high mortality rates. Despite all recent advanced treatments such as use of inotropes, vasoconstrictors and intra-aortic balloon pump (IAPB) therapy, revascularization techniques and application of different systems of mechanical circulatory support, CS is still the most common cause of hospital mortality ranging between 60%-70% compared to patients with AMI without advanced CS whose hospital mortality is about 10% [1]. Cardiac arrest is a major cause of unexpected death and complicates about 22% of patients with acute myocardial infarction [2]. Cardiac arrest has a poor prognosis, and despite con‐ ventional cardiopulmonary resuscitation (CPR) maneuvers, only a few patients can fully return to a normal lifestyle. The main reasons for very poor outcome and prognosis in CA are a lack of return of spontaneous circulation (ROSC), a long time of CPR [3],[4], re-arrest from hemodynamic instability after ROSC, hypoxic encephalopathy [5], out-of-hospital CA [6-8]. In both refractory CS and CA secondary AMI, which are very critical circumstances, VenoArterial Extracorporeal Membrane Oxygenation (V-A ECMO) has been proposed and utilized during the last decades to obtain rapid resuscitation, stabilization, and subsequent triage to a more permanent treatment strategy.